Medicare Reimbursement for the ASC

The delivery of eye care services has undergone many changes in recent years. In particular, ophthalmic surgeons now perform major procedures in an ambulatory surgery center (ASC) more often than in a hospital outpatient department (HOPD). Within the Medicare system, eye surgery ranks in the top three groupings of ASC services; the other two popular services are endoscopy and pain management. For the future, the Centers for Medicare & Medicaid Services (CMS) expects an increase in the number of procedures performed in ASCs.

Beginning January 1, 2008, CMS inaugurated a new payment system for ASCs that relies heavily on the current methodology for HOPD reimbursement. This monograph describes the system in detail as well as related issues that grew out of this dramatic change.


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